The cost of health care has been on an unsustainable upward path, and the burden is finally becoming too large for the nation to bear. With costs that are higher than those of other developed nations and outcomes that are not commensurately better, the question is finally being asked – what are we paying for, and is it worth it?

Our current system puts private, third-party payers in a key position as this new dynamic unfolds. Because they provide the financial incentives that drive behavior through a large portion of the healthcare system, and because of their relatively sophisticated understanding of the system as a whole, they are in a position to advocate for specific interventions on the basis of clinical value and financial cost, and to shape clinical practice through the incentives they offer.